A diaphragm is a dome-shaped latex (rubber) cup which is
inserted into the vagina before intercourse and covers the cervix.
Types
Flat spring (flat metal band)
Coil spring (coiled wire)
Arching spring (combination metal spring)
Mechanisms of Action
Prevent sperm from gaining access to upper reproductive tract (uterus and fallopian
tubes) and serve as a holder of spermicide
Benefits
Contraceptive
- Effective immediately
- Do not affect breastfeeding
- Do not interfere with intercourse (may be inserted up to 6 hours before)
- No method-related health risks
- No systemic side effects
Noncontraceptive
- Some protection against STDs (e.g., HBV, HIV/AIDS) especially when used with spermicide
- Contain menstrual flow when used during menses
Limitations
- Moderately effective (6–18 pregnancies per 100 women during the first year when
used with spermicide)
- Effectiveness as contraceptive depends on willingness to follow instructions
- User-dependent (require continued motivation and use with each act of intercourse)
- Pelvic examination by trained service provider (may be nonphysician) required for
initial fitting and postpartum refitting
- Associated with urinary tract infections in some users
- Must be left in place for 6 hours after intercourse
- Supplies must be readily available before intercourse occurs
- Resupply must be available (spermicide required with each use)
Who Can Use A Diaphragm
- Women who prefer not to use hormonal methods or who should not use them (e.g., smokers
over 35 years of age)
- Women who prefer not to or should not use IUDs
- Women who are breastfeeding and need contraception
- Women wanting protection from STDs and whose partners will not use condoms
- Couples needing a temporary method while awaiting another method
- Couples needing a backup method
- Couples who have intercourse infrequently
- Couples in which either partner has more than one sexual partner (at high risk for
STDs), even if using another method
Who Should Not Use A Diaphragm
- Women whose age, parity or health problems make pregnancy high risk
- Women with histories of toxic shock syndrome
- Women with repeated urinary tract infections (UTIs)
- Women with uterine prolapse (uterus protruding into the vagina)
- Women with severe cystocele or rectocele (bulging of the walls of the bladder or rectum
into the vagina)
- Women with vaginal stenosis (narrowing of the vaginal canal)
- Women with genital anomalies
- Women with physical disabilities or who find it unpleasant to touch their genitals
(vulva and vagina)
- Couples who need a highly effective method of contraception
- Couples not willing to use correctly and with each act of intercourse
Management of Common Side Effects
SIDE EFFECT |
MANAGEMENT |
| Urinary tract infections (UTIs) |
Treat with appropriate
antibiotic. If client has frequent UTIs and diaphragm remains her first choice for
contraception, advise emptying bladder (voiding) immediately after intercourse. Offer
client postcoital prophylactic (single dose) antibiotic. Otherwise, help client to choose
another method. |
| Suspected allergic reaction (diaphragm) |
Allergic reactions,
although uncommon, can be uncomfortable and possibly dangerous. If symptoms of vaginal
irritation, especially after intercourse and no evidence of GTI, help client choose
another method. |
| Suspected allergic reaction (spermicide) |
Allergic reactions,
although uncommon, can be uncomfortable and possibly dangerous. If symptoms of vaginal
irritation, especially after intercourse and no evidence of GTI, provide another
spermicide or help client choose another method. |
| Pain from pressure on bladder/rectum |
Assess diaphragm fit.
If current device is too large, fit with smaller device. Follow up to be sure problem is
solved. |
| Vaginal discharge and odor if left in place for more
than 24 hours |
Check for GTI or
foreign body in vagina (tampon, etc.). If no GTI or foreign body is present, advise client
to remove diaphragm as early as is convenient after intercourse, but not less than
6 hours after last act. (Diaphragm should be gently cleaned with mild soap and water after
removal. Powder or talc should not be used when storing diaphragm.) If GTI, manage
as appropriate. |
Client Instructions
- Use the diaphragm every time you have intercourse.
- First, empty your bladder and wash your hands.
- Check the diaphragm for holes by pressing the rubber and holding it up to the light or
filling it with water.
- Squeeze a small amount of spermicidal cream or jelly into the cup of the diaphragm. (To
make insertion easier, a small amount of cream/jelly can be placed on the leading edge of
the diaphragm or in the opening to the vagina.) Squeeze the rim together.
- The following positions may be used for inserting the diaphragm:
- One foot raised up on a chair or toilet seat
- Lying down
- Squatting
- Spread the lips of the vagina apart.
- Insert the diaphragm and cream/jelly back in the vagina and push the front rim up behind
the pubic bone.
- Put your finger in the vagina and feel the cervix (feels like your nose) through
the rubber to make sure it is covered.
- The diaphragm can be placed in the vagina up to 6 hours before having intercourse. If
intercourse occurs more than 6 hours afterwards, another application of spermicide must be
put in the vagina. Additional cream or jelly is needed for each repeated intercourse.
- Leave the diaphragm in for at least 6 hours after the last time intercourse occurs. Do
not leave it in more than 24 hours before removal. (Vaginal douching is not recommended at
any time. If done, vaginal douching should be delayed for 6 hours after intercourse.)
- Remove diaphragm by hooking finger behind the front rim and pulling it out. If
necessary, put your finger between the diaphragm and the pubic bone to break the suction
before pulling it out.
- Wash the diaphragm with mild soap and water and dry it thoroughly prior to returning it
to container.
CAUTION
If toxic shock syndrome (TSS) is suspected, refer client to center where
intravenous fluids and antibiotics are available. Give oral rehydration as needed and a
non-narcotic analgesic (NSAID or aspirin) if fever is high (> 38°C).
When used properly, the risk of TSS among diaphragm users is insignificant.
Client should know how to use method properly and be aware of warning signs. |
Who Can Provide
- Physicians
- Nurses, Midwives, Paramedics
Where They Can Be Provided
- Hospitals
- Clinics
- Health Posts
- Private Offices
 
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